Form 656-B, Offer in Compromise Booklet - Internal Revenue Service

Section 7Monthly Household Income and Expense InformationPage 6 of 8Enter your household's gross monthly income. The information below is for yourself, your spouse, and anyone else who contributes to your household'sincome. The entire household includes spouse, significant other, children, and others who contribute to the household. This is necessary for the IRS toaccurately evaluate your offer.Monthly Household IncomeRound to the nearest whole dollar.Primary taxpayerWages$+ $Social SecurityPension(s)+ $Other Income (e.g. unemployment)+ $Total primarytaxpayer income = (30) $Spouse/Other IncomeWages$Social Security+ $Pension(s)+ $Other Income (e.g. unemployment)+ $Total spouse =income(31) $Interest and dividends (32) $Distributions (e.g., income from partnerships, sub-S Corporations, etc.) (33) $Net rental income (34) $Net business income from Box C (35) $Child support received (36) $Alimony received (37) $Round to the nearest whole dollar.Do not enter a negative number. If any line item is a negative, enter "0".Add lines (30) through (37) and enter the amount in Box D =Box DTotal Household Income$Are there additional sources of income used to support the household, e.g. non-liablespouse, or anyone else who may contribute to the household income, etc.?If yes, include the income on line 31 “Spouse/Other Income” above, as appropriate.YesNoMonthly Household ExpensesEnter your average monthly expenses.Note: Expenses may be adjusted based on IRS Collection Financial Standards. The standards may be found at www.irs.gov.Food, clothing, and miscellaneous (e.g., housekeeping supplies, personal care products , minimum payment on credit card).A reasonable estimate of these expenses may be used. (38) $Housing and utilities (e.g., rent or mortgage payment and average monthly cost of property taxes, home insurance, maintenance,dues, fees and utilities including electricity, gas, other fuels, trash collection, water, cable television and internet, telephone, and cellphone). (39) $Vehicle loan and/or lease payment(s) (40) $Vehicle operating costs (e.g., average monthly cost of maintenance, repairs, insurance, fuel, registrations, licenses, inspections,parking, tolls, etc.). A reasonable estimate of these expenses may be used. (41) $Public transportation costs (e.g., average monthly cost of fares for mass transit such as bus, train, ferry, taxi, etc.). A reasonableestimate of these expenses may be used. (42) $Health insurance premiums (43) $Out-of-pocket health care costs (e.g. average monthly cost of prescription drugs, medical services, and medical supplies likeeyeglasses, hearing aids, etc.) (44) $Court-ordered payments (e.g., monthly cost of any alimony, child support, etc.) (45) $Child/dependent care payments (e.g., daycare, etc.) (46) $Life insurance premiums (47) $Current taxes (e.g., monthly cost of federal, state, and local tax, personal property tax, etc.) (48) $Round to the nearest whole dollar.Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 1-2014)